Han Win Min, Wu Kunling, Tassiopoulos Katherine, Knowles Kevin, Ailstock Kate, Cummings Morgan, Kerr Stephen, Ponatshego Ponego, Mosepele Mosepele, Utay Netanya S, Avihingsanon Anchalee, Funderburg Nicholas T, Erlandson Kristine M
HIV-NAT, Thai Red Cross AIDS and Infectious Disease Research Centre, and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
The Kirby Institute, UNSW Sydney, Sydney, Australia.
AIDS. 2025 Aug 14. doi: 10.1097/QAD.0000000000004324.
Associations between inflammatory markers and prevalent or incident frailty, cognitive impairment, clinical events and mortality in older people with HIV are poorly understood.
An observational cohort study.
Participants ≥50 years from the ACTG HAILO cohort study were included. Participants completed annual evaluations for cognitive impairment and frailty. Clinical events included non-AIDS-defining cancers, diabetes and cardiovascular, liver and kidney diseases. Associations between inflammatory markers (hsCRP, IL-6, TNFR1, CXCL-9 and inflammatory index score [IIS]) at baseline and prevalence and incidence of frailty, cognitive impairment, any clinical event and non-accidental mortality were examined. We used 10-fold cross validation to examine whether the combination of inflammatory markers and frailty improved the ability to predict incident outcomes.
Among 484 participants (17% assigned female at birth, 25% Black and 20% Hispanic), median age was 56 years. Median BMI was 27 kg/m 2 , median CD4 count was 627 cells/mm 3 , and 95% had HIV-1 RNA <200 copies/mL. HsCRP, IL-6, TNFR1, CXCL-9 and IIS were associated with increased risk of prevalent frailty and clinical events, but not cognitive impairment. CXCL-9 (Q4 vs. Q1) and TNFR1 were associated with an increased incidence of both frailty and clinical events; Q4 vs Q1 of the IIS was associated with clinical events; increased inflammatory markers (except CXCL-9) were associated with an increased risk of mortality. TNFR1 combined with frailty modestly improved the predictability of incident clinical events and mortality over frailty alone.
Several inflammatory markers were associated with increased risk of frailty, clinical events, and mortality, but not cognitive impairment.
在感染艾滋病毒的老年人中，炎症标志物与普遍存在的或新发的虚弱、认知障碍、临床事件及死亡率之间的关联尚不清楚。
一项观察性队列研究。
纳入来自ACTG HAILO队列研究中年龄≥50岁的参与者。参与者每年接受认知障碍和虚弱评估。临床事件包括非艾滋病定义的癌症、糖尿病以及心血管、肝脏和肾脏疾病。研究了基线时炎症标志物（高敏C反应蛋白、白细胞介素-6、肿瘤坏死因子受体1、CXC趋化因子配体9和炎症指数评分[IIS]）与虚弱、认知障碍、任何临床事件和非意外死亡的患病率及发病率之间的关联。我们使用10倍交叉验证来检验炎症标志物与虚弱的组合是否能提高预测新发结局的能力。
在484名参与者中（17%出生时被指定为女性，25%为黑人，20%为西班牙裔），中位年龄为56岁。中位体重指数为27kg/m²，中位CD4细胞计数为627个/mm³，95%的人艾滋病毒-1核糖核酸<200拷贝/mL。高敏C反应蛋白、白细胞介素-6、肿瘤坏死因子受体1、CXC趋化因子配体9和炎症指数评分与普遍存在的虚弱和临床事件风险增加相关，但与认知障碍无关。CXC趋化因子配体9（四分位数4与四分位数1相比）和肿瘤坏死因子受体1与虚弱和临床事件的发病率增加相关；炎症指数评分的四分位数4与四分位数1相比与临床事件相关；炎症标志物升高（CXC趋化因子配体9除外）与死亡风险增加相关。肿瘤坏死因子受体1与虚弱相结合，相对于单独的虚弱，适度提高了新发临床事件和死亡率的可预测性。
几种炎症标志物与虚弱、临床事件和死亡率风险增加相关，但与认知障碍无关。
